Ostomy appliances for effluent control

ABSTRACT

A stoma extender includes a first end for insertion into a stoma for diverting stomal effluent into the stoma extender before the effluent exits the stoma; a second end for remaining external of the stoma, for providing a discharge exit for stomal effluent; and a conduit portion coupled between the first and second ends for communicating stomal effluent through the stoma extender, wherein the length of the conduit portion is adjustable stably, to permit adaptation of the stoma extender to an individual&#39;s stoma.

The present invention relates to the field of ostomy appliances forfitting and sealing within and around an ostomate's stoma to directeffluent output. Other aspects of the invention relate to the ability toadjust to the varying distance between the fascia and the skin and theability to “self-inflate” via fluidic actuation. The term “ostomy” isintended to cover at least colostomy, ileostomy and urostomy.

BACKGROUND TO THE INVENTION

Effectively directing or otherwise controlling effluent output iscentral to ostomy devices designed to protect skin adjacent to thedischarge area. Creating a seal around a person's stoma, such that theseal is dependable, comfortable and conducive to body tissue, isimportant for the function of ostomy appliances. Once this seal has beenmade, the appliance may use one or more of a variety of techniques formanaging stomal discharge. The formation of such a seal remains an areaof continuous improvement and development, since the performance andcomfort of the seal is fundamental to customer acceptance. Theprotection of the external peristomal tissue where the normal skin andstoma tissue meet is an essential characteristic of such an ostomydevice. Peristomal tissue can be extremely sensitive. Irritation canresult if the peristomal tissue is exposed to body waste, or to repeatedapplication and removal of adhesive or other sealants.

Ideally, the stoma should protrude from the abdominal surface of theostomate by a distance ranging from 0.5 cm to 2.5 cm. This protrusionforms a spout, from which effluent can discharge directly into thepouch. However, in many cases, the stoma protrudes by a lesser amount ornot at all. For example, a “flush stoma” is a condition when the stomareaches only as far as the surface of the abdomen; a “recessed stoma” isa condition when the stoma does not even reach the surface of theabdomen, and the peristomal skin is drawn into a funnel shaped mouthbetween the stoma and the abdominal surface. There are many potentialcauses for these conditions. These can include improper formation of thestoma by the surgeon; and post-operative weight gain by the ostomate.Post-operative weight gain causes the ostomate's abdominal region toexpand in girth while the length of the intestine attached to theabdomen remains fixed, thereby resulting in the stoma being pulledtoward and ultimately below the surface of the abdomen.

Flush and recessed stomas can be difficult to manage, because someeffluent discharged from the stoma can tend to pool around the stoma,instead of the effluent discharging completely into the pouch. Stoolretained in this manner can attack the interface between the adhesivebody fitment and the ostomate's peristomal skin. Such attack reduces theadhesion of the body fitment to the skin, thereby reducing theeffectiveness and the usable life of the appliance. The stool can alsocause irritation and degradation of the peristomal skin itself. Stoolexiting the stoma may contain digestive juices from the body, and suchjuices can attack the peristomal skin resulting in excoriation. It ishitherto not known for a single device to accommodate varying distancesbetween the stoma and skin level.

Some known devices use a single expandable balloon or member inside thestoma to form a seal against the inside wall of the opening, and a fixedstop or surface against the outside of the body. However, such deviceshave to be designed carefully to avoid the risk of damage to thesensitive internal tissue. In such designs, a relatively highconcentration of force may be placed on the tissue underneath the stoma,effecting blood circulation in the area under pressure, thereby overtime leading to tissue necrosis.

By way of example, U.S. Publication No. 2003/0220621 describes a valvedostomy device including a hollow discharge tube and anchoring means foranchoring the tube in the stoma. The anchoring means comprises aninflatable balloon cuff inserted in the stoma to anchor the tube againstthe stomal wall, and a screw threaded clamp as an outer stop surface.Although the screw threaded clamp has a conformable pad, the anchoringmeans bears the entire weight of the ostomy appliance and any collectiondevice attached to it. Thus, the strength of the attachment has to beoffset against limitations on the clamping force which can be appliedthrough the peristomal tissue without causing discomfort and tissuedamage, and the inflation pressure of the balloon cuff without causinginternal tissue damage to the stoma lumen. Additionally, the device hasvery little or no range of adjustment to the varying distance betweenthe underside of the fascia and the skin, limiting the use toindividuals whose fascia-skin distance is within the range of thedevice. Also, the means of inflating the device requires a secondarymechanism such as a syringe or pump to inflate it. To have the usercarry around an extra component is inconvenient, and the inflationmechanism may not have a means to control the amount of fluid to bepumped into the device, which brings associated risks of under orover-inflation of the device.

EP 0168967, EP 1346711 and U.S. Pat. No. 4,950,223 describe ostomy portscomprising a single inflatable balloon inserted into the stoma, and anexternal adhesive wafer for securing the appliance to the skin aroundthe stoma. Such designs are concerned primarily with the formation of aseal inside the stoma lumen. The peristomal tissue is either unprotectedor is protected by the adhesive wafer, leaving the possibility that theperistomal tissue may be vulnerable to the conventional problem ofirritation and pain resulting from exposure to stool or repeatedapplications and removals of adhesive. As in the previous referenceddevice, there are also no significant accommodations for the variationin fascia-skin distance or the fact that a secondary component isrequired for inflation.

SUMMARY OF THE INVENTION

The present invention is generally directed to a stoma extender having afirst end for insertion into a stoma for diverting stomal effluent intothe stoma extender before the effluent exits the stoma, a second end forremaining external of the stoma, for providing a discharge exit forstomal effluent, and a tubular portion or conduit portion coupledbetween the first and second ends for communicating stomal effluentthrough the stoma extender.

Optional aspects of the invention include (i) the length of the conduitportion being adjustable stably to enable the stoma extender to beadapted to an individual's stoma; (ii) a seal for the first end, theseal including a plurality of resilient fingers and elastic webbingextending at least between portions of the fingers; (iii) a seal for thefirst end, the seal comprising a material configured to expand whencontacted by moisture; (iv) a collapsed configuration of the first endand, optionally, a portion of the tubular member or conduit portion, thecollapsed configuration being retained by a water-soluble and/orwater-dispersible glue or coating, such as gelatin; (v) an inflationfluid reservoir integrated in the stoma extender for inflating a seal atthe first end, thereby avoiding the user having to carry additionalinflation equipment; and/or (vi) a collar slidable on the tubular memberand retained selectively by a selective engagement device. The selectiveengagement device may be manually operable, or it may be directionallyresponsive.

These ideas may be used independently, or any two or more of the aboveideas may be used in combination. The invention explicitly envisages allsuch possible combinations and permutations.

There are several embodiments of the invention. These illustrate theabove and other aspects of: a means of sealing against the intestinalwall; an ability to adjust to the varying fascia-skin distances andprovide an elastic range to accommodate movement; a means of insertionand removal from the stoma; and a feature of “self-inflation” by meansof internally containing the fluidic pressure to actuate and/or deploythe device. Each embodiment may incorporate one or more of theseaspects.

Additional features usable in combination with this invention aredescribed in co-pending applications U.S. Application Nos. 60/891,120and 60/891,127, the contents of which are hereby incorporated byreference.

Other aspects of the present invention, and additional features usablein combination with the foregoing, include:

(a) The seal may comprise an inflatable chamber portion for sealingagainst the internal wall of the stoma. The inflatable chamber istoroidal in shape and is sealed to or continuous with a tubularstraight, tapered or “trumpet-shape” central channel constructed of athin elastic material.

(b) The seal may comprise a first inflatable chamber portion for sealingagainst the internal wall of the stoma, and a second inflatable chamberportion for sealing externally of the stoma.

(c) The seal may be positioned in the aperture of an adhesive member.The seal may include an inflatable chamber portion and a support. Thesupport may provide a backbone for the inflatable chamber portion. Theinflatable chamber portion may allow the support to float somewhat withrespect to the adhesive member.

(d) The seal may include an inflatable chamber portion that is locatedin the aperture of an adhesive member, and is configured to sealexternally of the stoma, without substantially occluding the stoma. Atubular member or passage may optionally extend through the externalinflatable chamber portion for discharge of body waste. The inflatableseal may allow the discharge of body waste without removal of theinflatable seal from the stoma.

(e) The seal comprising the internal portion for sealing against theinternal wall of the stoma may be constructed of a non-inflatabletoroidal member, i.e., an O-ring. This member is attached and/or bondedto or is of a continuously formed shape with a generally tubular elasticmember that extends through the stoma opening creating a passageway outof the body.

(f) The seal comprising the internal portion for sealing against theinternal wall of the stoma may be constructed, in the deployed state, ofa non-inflatable funnel-shaped member possessing finger-likeprotrusions, roughly like the supporting members of an umbrella, but inthe opposite direction of deployment. These protrusions are continuouswith a ringed feature at their base that provides a support to maintaina central opening, in particular, if there is a radial force to effectclosing of the fingers. This funnel-shaped member is constructed offlexible and/or elastic material such that it is rigid enough tomaintain shape but flexible and soft enough to easily close the fingersto affect a somewhat cylindrical shape. The end of the fingers curveinward with a radius so as to prevent the concentration of force at thefinger ends when contacting the intestinal wall. Over this funnel-shapedmember is attached/bonded or otherwise constructed continually a thinhighly elastic covering, so as to create webbing between the fingers anda sealed central tubular passageway from the end of the supportingringed feature. The central tubular passageway extends through the stomaopening and out of the body. The central tubular passageway may be of atubular straight, tapered or “trumpet” shape. Another embodiment mayhave the supporting ringed feature extend through the stoma and out ofthe body. A tubular shaped insertion tool may be used to engage thecurved ends of the fingers in the closed state. Once the distal end ofthe device in place inside the stoma the tool is removed and the shapememory of the funnel-shaped member deploys the device. It may be thatthe highly elastic covering is an over-molding where the fingers, formedoriginally in a pre-loaded state, are held in tension during theover-molding process so that when the completed device is deployed thehighly elastic covering retains a stretched condition to maintain theseal to the intestinal wall.

(g) The seal comprising the internally inflated chamber portion may beconstructed of a single chamber or dual interconnecting chambersattached and/or bonded to, or constructed of one formed shape, with atubular, more firm or rigid central member. The proximal end of thisassembly or component may be attached to another more elastic tubularmember, or the central member itself continues outside the body, so asto provide a passageway through the device. With embodiments having theother more elastic tubular member, the shape may be tubular straight,tapered or “trumpet-like”. The assembly/component comprising the singleor dual chambers, and the more firm central tubular member, are to beinserted fully behind the fascia and inflated, while the proximal end ofthe central member or the more elastic straight, tapered or “trumpet”shaped tubular member remains external to the stoma. This assemblyconfiguration may allow for easy insertion into the stoma openingwithout the need for an insertion device.

(h) The member comprising the seal external to the stoma may beconstructed of a thicker toroidal-shaped elastic material or O-ring suchthat when the internal member is deployed within the stoma the externalmember may be manually “rolled up” by the user, utilizing thecircumferential detent of the toroidal shape and the elastic rebound ofthe interconnecting tubular member or passage, so as to accommodate thevarying fascia-skin distance. The interconnecting tubular member maycomprise the range of characteristics from thin and highly elastic tobeing constructed of more rigid material, and may be of a tubulartapered or “trumpet” shape.

(i) The member comprising the seal external to the stoma may not only beconstructed of a thicker toroidal-shaped elastic material or O-ring fora manual circumferential detent adjustment to the fascia-skin distance,but may also contain a pressurized chamber, i.e., an inflatable O-ring.This chamber is to be pressurized with fluid at manufacture or at sometime previous to use, such that the pressure contained, when released,can be utilized to transfer, via elastic action, the fluidic componentthrough interconnecting passageways into the internal chamber so theinternal chamber may be deployed while within the body, therebyeliminating the need of a secondary component for inflating the device.An orifice or other fluid restriction, or valve may be used at theentrance, exit or along the interconnecting passageways to delay devicedeployment to allow the user sufficient time for device insertion. Theinternal chamber may be constrained, e.g., folded, rolled and/ortwisted, into a thin, long shape to ease insertion into the stoma priorto device deployment without the need for an insertion tool. Gelatine orother coating on the constrained internal chamber may facilitateinsertion by maintaining the constraint until the gelatine contacts oris within the moist interior of the stoma. The addition of a cap overthe internal chamber may also aid in maintaining the chamber in aconstrained condition before use.

(j) The member external to the stoma may not comprise an external sealbut may only rest or attach and have “vents” allowing fluid escape inthe event the internal seal to the intestine is compromised. Theeffluent venting may prevent occlusion of the stoma opening in the eventof seal failure. The effluent venting may also be an indicator that thedevice is in need of replacement.

(k) The member external to the stoma, with embodiments that have amorefirm central tubular member, may be comprised of a more rigid material,effectively a collar, and may possesses features along the contactingsurface with the central member such that the collar may be manuallyplaced over and easily slid down the central member but will meet moreresistance moving up the central member. This may be accomplished viaangled, bendable protrusions with sharp ends extending radially inwardand contacting the central member so that movement in one direction(downward or distally) is facilitated but opposite movement (upward orproximally) is restrained. The restrained movement in the proximaldirection of the collar may not be full but measured so as to preventtissue damage in the event of excessive or unexpected body movement.Another embodiment may involve a locking feature within the collarwhereas once the collar is in place over the central tubular member asecond component of the collar interacts to squeeze the central tubularmember sufficiently so as to hold the collar in its position on themember.

(l) Successfully packaging the device embodiments possessing thepressurized external chamber or inflatable O-ring (ref. ‘i’ above) maybe accomplished by utilizing a container pressurized with the same fluidand to the same pressure as the device in the non-deployed state. Thismay alleviate the problem of the device depressurizing over time due tothe permeability of the device materials. The package container may beconstructed of barrier films or may be a hard polymer or an aluminum(e.g., like a soda can) or other container that will hold the fluidicpressure over time until the contained device is needed.

(m) The seal comprising the internal portion for sealing against theinternal wall of the stoma may be constructed of a rigid tubular memberwith a semi-spherical bulge at the distal end. The proximal end of thetubular member comprises a generally flange-shaped feature exterior tothe body so as to be clear of the stoma and attach to an external waferor component. Through the bulge are a series of holes. Over the exteriorof the tubular member is placed a covering of expandable foam material,which may be generally thicker over the bulge at the distal end. Thisfoam material expands significantly in the presence of moisture. Whenthe device is inserted the moisture and liquid effluent in the stomapass through the holes in the bulge and over the surface of the foamcausing the foam to expand and create a seal against the intestinalwall.

As used herein, the term “inflatable” means a chamber portion that isconfigured to be expanded by inflating the chamber with a positiveinflation pressure (e.g., a pressure of inflation fluid greater than theexternal pressure).

Features and advantages of the invention may include: providing anostomy seal that is comfortable and effective without creating highconcentrations of pressure internally or externally, and which canproduce a comfortable peristomal seal; the ability to adjust to thevarying fascia-skin distances and provide an elastic range toaccommodate movement; the means of insertion and removal from the stoma;and the feature of “self-inflation” by means of internally containingthe fluidic pressure to actuate and/or deploy the device.

Although certain features have been highlighted above and in theappended claims, the Applicant may seek claim protection for anyinventive feature and/or idea described and/or illustrated hereinwhether or not emphasis has been placed thereon.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic perspective view of a first embodiment of theinvention in an “unrolled” condition possessing features described in“e” and “h” above.

FIG. 2 is a schematic perspective view of a second embodiment of theinvention in an “unrolled” condition possessing features described in“e” and “h” above.

FIG. 3 is a schematic sectional view showing the first embodiment of theinvention in an “unrolled” condition.

FIG. 4 is a schematic perspective view of the first embodiment of theinvention in an “unrolled” condition illustrating the removal string ofthe device.

FIG. 5 is a schematic sectional view showing a third embodiment of theinvention in an “unrolled” and deployed condition possessing featuresdescribed in “f” and “h” above.

FIG. 6 is a schematic sectional view showing a fourth embodiment of theinvention possessing features described in “m” above.

FIG. 7 a is a schematic perspective view showing a fifth embodiment ofthe invention in an “unrolled” and inflated condition possessingfeatures described in “g” and “h” above.

FIG. 7 b is complementary schematic perspective views to FIG. 7 ashowing a fifth embodiment of the invention in an “unrolled” andinflated condition possessing features described in “g” and “h” above.

FIG. 8 is a schematic sectional view showing the fifth embodiment of theinvention in an “unrolled” and inflated condition.

FIG. 9 is a schematic sectional view a sixth embodiment of the inventionin an inflated condition possessing features described in “b” and “g”above.

FIG. 10 is a schematic perspective view showing a seventh embodiment ofthe invention in an inflated condition possessing features described in“g”, “j” and “k” above.

FIG. 11 is a schematic perspective view showing an eighth embodiment ofthe invention in an inflated condition possessing features described in“g”, “j” and “k” above.

FIG. 12 a is a schematic perspective view showing an ninth embodiment ofthe invention in an “unrolled” and inflated condition possessingfeatures described in “a” and “h” above.

FIG. 12 b is a complementary schematic perspective view to FIG. 12 ashowing an ninth embodiment of the invention in an “unrolled” andinflated condition possessing features described in “a” and “h” above.

FIG. 13 is a schematic sectional view showing the ninth embodiment ofthe invention in an “unrolled” and inflated condition.

FIG. 14 a is a schematic perspective views showing a tenth embodiment ofthe invention in an un-deployed condition possessing features describedin “a” and “i” above (but cannot be rolled).

FIG. 14 b is a complementary schematic perspective view to FIG. 14 ashowing a tenth embodiment of the invention in an un-deployed conditionpossessing features described in “a” and “i” above (but cannot berolled).

FIG. 15 is a schematic perspective view showing the tenth embodiment ofthe invention having the constraining cap removed.

FIG. 16 is a schematic perspective view showing the tenth embodiment ofthe invention being inserted into the stoma through a two piece ostomywafer.

FIG. 17 is a schematic perspective view showing the tenth embodiment ofthe invention inserted in the stoma through a two piece ostomy wafer butnot yet deployed.

FIG. 18 is a schematic sectional view showing the tenth embodiment ofthe invention inserted in the stoma through a two piece ostomy wafer butnot yet deployed.

FIG. 19 is a schematic sectional view showing the tenth embodiment ofthe invention inserted in the stoma through a two piece ostomy wafer anddeployed.

FIG. 20 is a schematic front perspective view showing the tenthembodiment of the invention inserted in the stoma through a two pieceostomy wafer and deployed.

FIG. 21 is a schematic perspective view showing an eleventh embodimentof the invention in an “unrolled” and inflated condition possessingfeatures described in “a” and “i” above (can be rolled).

FIG. 22 is a schematic sectional view showing the eleventh embodiment ofthe invention in an “unrolled” and inflated condition.

FIG. 23 is a schematic perspective view showing an example dip-moldingtool for creating the eleventh embodiment of the invention.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring to FIGS. 1-4, depicting the first and second embodiments, inwhich an ostomy appliance 10 may include a seal for sealing around astoma. The seal may generally comprise an O-ring or similar portion 11for insertion into the stoma and sealing against the internal wall ofthe stoma lumen, and a second O-ring or similar portion 12 for sealingand/or restraining against external tissue (skin) or an adhesivecomponent around the stoma. The two O-rings are attached or continuouswith a conduit portion or tubular member 13 so as to create a centralchannel 14 for stoma effluent to pass. The internal O-ring 11 isinserted into the stoma via an insertion tool (not shown) and placedjust beyond the abdominal wall (fascia). The external O-ring 12 is thengrasped and gently tugged outward to seat the internal O-ring 11 againstthe fascia. The second external O-ring 12 is then manually “rolled” ortwisted using the fingers to roll up the excess length of the tubularmember 13 so as to adjust to the specific distance between the fasciaand skin. The rolling action occurs in increments utilizing the naturalcircumferential detent of the O-ring 12. Once sufficient length has beentaken up the resistance of the circumferential detent acts to maintainthe position of the rolled up length. Additionally, the elastic reboundof the tubular member 13 provides an elastic range to accommodate bodymovement when the ostomy appliance 10 is worn. The addition of anadhesive on the skin or the adhesive component where the O-ring 12contacts the skin may aid in securing the ostomy appliance 10. In thefirst embodiment (FIGS. 1, 3 and 4), the shape of the tubular member 13is designed to exactly accommodate the diameter reduction resulting fromthe accumulation of material during the roll up adjustment, resulting ina slightly tapered shape to the tubular member 13 and a somewhat largediameter reduction near the distal end. This will allow for a wide rangeof fascia-skin adjustment and material elasticity.

In the second embodiment (FIG. 2), the shape of the tubular member 13 ismore “trumpet” shaped. This design reduces bunching of the tubularmember 13 material in the stoma but will add a radial force to theexternal O-ring 12 when rolled so the fascia-skin adjustment range maybe reduced. This may be compensated for by increasing the externalO-ring 12 rigidity and/or decreasing the O-ring 12 diameter and/orincreasing the elasticity of the tubular member 13 material. Refinementof this shape will depend on the applicable range of fascia-skindistance for a given ostomy appliance 10 size. Once the ostomy appliance10 is in place, stoma effluent passes through the central channel 14 andout of the body. If a two piece ostomy pouch system is used inconjunction with the ostomy appliance 10, the chance of effluent leakageshould be significantly reduced.

To effect easy removal of the ostomy appliance 10 a removal string 15 isattached in a specific way to the internal O-ring 11 (FIG. 4). Theremoval string 15, comprising of nylon, silk or other suitable material,is driven through and attached to the O-ring 11 from the front (distalside) and exits the back. The removal string 15 is then looped aroundand run through the central channel 14 where it is suitably adhered tothe skin or ostomy wafer above the opening of the central channel 14 byway of an attached adhesive strip 16. When the user wishes to remove theostomy appliance 10 the removal string 15 is gently pulled. This twiststhe internal O-ring 11 in a manner that collapses the O-ring shape andallows the O-ring 11 to more easily pass through the stoma opening andout of the body and discarded.

In a third embodiment of the ostomy appliance 10, referring to FIG. 5,an ostomy appliance 10 may include a seal for sealing around a stomasuch that the seal comprising the internal portion for sealing againstthe internal wall of the stoma lumen consists of a funnel-shaped member18 possessing finger-like protrusions 17. These protrusions 17 arecontinuous with a ringed feature 19 at their base that provides supportto maintain the opening of the central channel 14 through thefunnel-shaped member 18. The dimensions of the protrusions 17 inconjunction with the flexible and/or elastic material properties of thefunnel-shaped member 18 are designed so that the member 18 is rigidenough to maintain shape, but flexible and soft enough to bend theprotrusions 17 together to achieve a cylindrical shape for the member18. The ends 20 of the protrusions 17 curve inward with a radius so asto prevent the concentration of force at the ends 20 when contacting theintestinal wall. Over the outside of the funnel-shaped member 18 isformed a thin, continuous, highly elastic covering 21 so as to create acollapsible and stretchable webbing between the protrusions 17 and asealed central channel 14 from the end of the ringed feature 19. Thiselastic covering 21 is bonded to or otherwise attached to thefunnel-shaped member 18. It may be that the elastic covering 21 is anover-molding, where the protrusions 17 are formed prior to theover-molding in a pre-loaded state, such that during the over-moldingprocess the protrusions 17 are held in tension so that when thecompleted ostomy appliance 10 is deployed in situ, the webbing portionof the elastic covering 21 retains a stretched condition to maintain theseal to the intestinal wall. The elastic covering 21 which forms thecentral channel 14 extends through the stoma opening and out of the bodywhen the ostomy appliance 10 is in place. The shape of the elasticcovering 21, which forms the central channel 14, is similar to theproximal portion of the tubular member 13 of the second embodiment above(FIG. 2), where the shape of the elastic covering 21 is “trumpet-shaped”and attached to an external O-ring 12, so as to function similarly as anadjustment to the various fascia-skin distances.

In another embodiment the shape of the elastic covering 21, which formsthe central channel 14 may also be of a tubular tapered shape attachedto an external O-ring 12 as in the first embodiment above (FIGS. 1, 3and 4).

Still another embodiment may have the supporting ringed feature 19extend in a tubular straight shape through the stoma passageway and outof the body.

The means of inserting the ostomy appliance 10 into the stoma mayinvolve the use of a tubular shaped insertion tool (not shown). The toolis placed through the central channel 14 from the proximal end of theostomy appliance 10, passes through the ringed feature 19, and the toolend engages the curved ends of the protrusions 17 when they are benttogether into a cylindrical shape. The tool may be held in place byadhesive and/or engaging features at the tool end. The protrusions 17may also possess adhesive and/or engaging features. The tool may also beheld in place via a feature that maintains a fit with the ringed feature19 and/or the proximal end of the tool and ostomy appliance 10. Theinsertion tool may be fixed in place at manufacture and packaged tofacilitate user insertion.

The third embodiment of the ostomy appliance 10 is inserted into thestoma opening via the insertion tool and the tool is then disengaged andremoved, allowing the shape memory of the funnel-shaped member 18 todeploy the ostomy appliance 10 and create a seal against the intestinalwall. As with the first and second embodiments the external O-ring 12 isthen grasped and manually “rolled” or twisted using the fingers to rollup the excess length of the elastic covering 21, which forms the centralchannel 14, so as to adjust to the specific distance between the fasciaand skin. The elastic rebound of the elastic covering 21, which formsthe central channel 14, also provides an elastic range to accommodatebody movement when the ostomy appliance 10 is worn. The addition of anadhesive on the skin or on an adhesive component where the externalO-ring 12 contacts, may aid in securing the ostomy appliance 10.

The shape memory of the funnel-shaped member 18 is measured so that theforce required to simply pull the ostomy appliance 10 out of the stomais such that it does not inflict tissue damage and is comfortable to theuser.

In a fourth embodiment of the ostomy appliance 10, referring to FIG. 6,an ostomy appliance 10 may include a seal for sealing around a stomasuch that the seal comprising the internal portion for sealing againstthe internal wall of the stoma lumen consists of an expandable foammaterial 22. This foam material 22 covers the exterior of a more rigidcentral support 23 that is of a generally tubular shape, but having asemi-spherical bulge 24 at the distal end and flange-like feature 25 atthe proximal end. The foam material 22 may have varying thicknesses overdifferent portions of the central support 23, e.g., it may be thickerover the semi-spherical bulge 24. The foam material 22 expandssignificantly in the presence of moisture. Over the exterior of the foammaterial 22 may be a coating or covering of very thin, elastic sealingfilm 27. The flange-like feature 25 remains exterior to the body whenthe ostomy appliance 10 is in place so as to be clear of the stoma, andmay attach to the skin, an external wafer or other component. Theflange-like feature 25 may be shaped generally flat, convex, concave ora combination of these. Through the semi-spherical bulge 24 are a seriesof holes 26 for allowing moisture to pass through the central support23. There may be additional holes 26 at other points along the centralsupport 23.

The ostomy appliance 10 may be manually inserted through the aperture ofa two-piece ostomy wafer and into the stoma and the flange-like feature25 may then attach to the wafer. The moisture and liquid effluent in thestoma pass into the central channel 14 and through the holes 26 in thecentral support 23 and into the foam material 22 causing the foammaterial 22 to expand, stretching the sealing film 27 and creating aseal against the intestinal wall.

The ostomy appliance 10 is removed manually by detaching the ostomyappliance 10 from the ostomy wafer and pulling it out of the stoma anddiscarded.

In a fifth embodiment of the ostomy appliance 10, referring to FIGS. 7and 8, an ostomy appliance 10 may include a seal for sealing around astoma such that the seal comprising the internal portion for sealingagainst the internal wall of the stoma lumen consists of an internallyinflated chamber portion 28 that may be constructed of dualinterconnecting chambers 29 attached and/or bonded to, or constructed ofone formed shape, with a tubular more firm or rigid central member 30.The inflated chamber portion 28 may be attached to another more elastictubular member 31 similar to the proximal portion of the tubular member13 of the second embodiment above (FIG. 2), where the shape of theelastic tubular member 31 is “trumpet-shaped” and attached to anexternal O-ring 12, so as to function similarly as an adjustment to thevarious fascia-skin distances. In another embodiment the shape of theelastic tubular member 31, which also forms part of the central channel14, may also be of a tubular tapered shape attached to an externalO-ring 12 as in the first embodiment above (FIGS. 1, 3 an 4).

The inflated chamber portion 28 of the fifth embodiment of the ostomyappliance 10 is inserted fully behind the fascia. The proximal end ofthe ostomy appliance 10, which includes a portion of the elastic tubularmember 31 and the attached O-ring 12, remains external to the stoma. Thedual interconnecting chambers 29 are then inflated via an inflation tube32 that has a check valve, and an inflation device such as a syringe.Once inflated, as with previous embodiments, the external O-ring 12 isthen grasped and gently tugged outward to seat the most proximal of thedual interconnecting chambers 29 against the fascia. The external O-ring12 is then manually rolled so as to adjust to the specific distancebetween the fascia and skin. The firmness of the external O-ring 12 actsto maintain the position of the rolled up length and the elastic reboundof the tubular member 31 provides an elastic range to accommodate bodymovement when the ostomy appliance 10 is worn. Also, as with previousembodiments, the addition of an adhesive on the skin or the adhesivecomponent 33 where the O-ring 12 contacts may aid in securing the ostomyappliance 10. This assembly configuration may allow for easy insertioninto the stoma opening without the need for an insertion device.

The ostomy appliance 10 is removed by deflating the interconnectingchambers 29 and pulling the ostomy appliance 10 out of the body anddiscarded.

In a sixth embodiment of the ostomy appliance 10, referring to FIG. 9,an ostomy appliance 10 may include a seal for sealing around a stomasuch that the seal comprising the internal portion for sealing againstthe internal wall of the stoma lumen consists of an internal inflatedchamber 34 and an external portion for restraining against externaltissue consisting of an external inflated chamber 35 that may befluidically interconnected and attached and/or bonded to, or constructedof one formed shape, with a tubular more firm or rigid central member36.

The internal chamber 34 and the portion of the central member 36, up tojust before the external chamber 35, of the ostomy appliance 10 isinserted into the stoma. The interconnected chambers, 34, 35, are theninflated via an inflation tube 32 that has a check valve, and aninflation device.

The ostomy appliance 10 is removed by deflating the interconnectedchambers, 34, 35 and pulling the ostomy appliance 10 out of the body anddiscarded.

In a seventh embodiment of the ostomy appliance 10, referring to FIG.10, an ostomy appliance 10 may include a seal for sealing around a stomasuch that the seal comprising the internal portion for sealing againstthe internal wall of the stoma lumen consists of a internal inflatedchamber 34 attached and/or bonded to, or constructed of one formedshape, with a tubular more firm or rigid central member 36. The centralmember 36 continues outside the body, so as to provide a passagewaythrough the ostomy appliance 10. The member external to the stoma may becomprised of a more rigid material, effectively a collar 37, and maypossess features along the contacting surface with the central member 36such that the collar 37 may be manually placed over and easily slid downthe central member 36 but will meet more resistance moving up thecentral member 36. This may be accomplished via angled, bendableprotrusions 38 with sharp ends extending radially inward and contactingthe central member 36 so that movement in one direction (downward ordistally) is facilitated but opposite movement (upward or proximally) isrestrained. The restrained movement in the proximal direction of thecollar 37 may not be a rigid stop but measured so as to prevent tissuedamage in the event of excessive or unexpected body movement. Anotherembodiment may involve a locking feature (not shown) within the collar37 whereas once the collar 37 is in place over the central member 36 asecond component of the collar 37 interacts to squeeze the centralmember 36 sufficiently so as to hold the collar 37 in its position onthe central member 36. The collar 37 shape is such as to be clear of thestoma, and may attach to the skin, an external wafer or other component.The collar 37 may be shaped generally flat, convex, concave or acombination of these. The collar 37 may not comprise an external sealbut may only rest or attach and have “vents” allowing fluid escape inthe event the internal seal to the intestine is compromised. Theeffluent venting may prevent occlusion of the stoma opening in the eventof seal failure. The effluent venting may also be an indicator that thedevice is in need of replacement.

The internal chamber 34 and the portion of the central member 36 of theostomy appliance 10 is inserted into the stoma and fully behind thefascia and inflated via an inflation tube 32 that has a check valve, andan inflation device. The central member 36 is then gently tugged in theproximal direction to seat the internal chamber 34 against the fascia.The collar 37 is then placed over the central member 36 and slid down torest against the skin, an external wafer or other component, then ifneeded locked in place. The central member 36 may have excess lengthtrimmed to reduce the profile of the ostomy appliance 10.

The ostomy appliance 10 is removed by deflating the internal chamber 34and pulling the ostomy appliance 10 out of the body and discarded.

The eighth embodiment of the ostomy appliance 10, referring to FIG. 11,has the same features and function as the seventh except there are dualinterconnecting chambers 29 similar to the fifth embodiment.

In a ninth embodiment of the ostomy appliance 10, referring to FIGS. 12and 13, an ostomy appliance 10 may include a seal for sealing around astoma such that the seal comprising the internal portion for sealingagainst the internal wall of the stoma lumen consists of an inflatablechamber 39 toroidal in shape and sealed to or continuous with a tubulartapered or “trumpet-shape” central channel 40 constructed of a thinelastic material. The tapered channel 40 may be attached to anotherelastic tubular member 31 similar to the proximal portion of the tubularmember 13 of the second embodiment above (FIG. 2), where the shape ofthe elastic tubular member 31 is “trumpet-shaped” and attached to anexternal O-ring 12, so as to function similarly as an adjustment to thevarious fascia-skin distances. In another embodiment the shape of theelastic tubular member 31, which also forms part of the central channel14, may also be of a tubular tapered shape attached to an externalO-ring 12 as in the first embodiment above (FIGS. 1, 3 and 4). Thedistal end of the ostomy appliance 10, including the inflatable chamber39, the distal end of the inflation tube 32 and the tapered channel 40with a portion of the elastic tubular member 31 may be constrained,e.g., folded, rolled and/or twisted, into a thin, long shape to easeinsertion into the stoma without the need for an insertion tool.Gelatine or other coating on the constrained members may facilitateinsertion by maintaining the constraint until the gelatine contacts oris within the moist interior of the stoma. The addition of a cap overthe internal chamber may also aid in maintaining the chamber in aconstrained condition before use.

The constrained distal end of the ninth embodiment of the ostomyappliance 10 is inserted fully into the stoma, so as the end is behindthe fascia. The proximal end of the ostomy appliance 10 which includes aportion of the elastic tubular member 31 and the attached O-ring 12remain external to the stoma. After the constraining coating hasdissolved, the inflatable chamber 39 is then inflated via an inflationtube 32 that has a check valve, and an inflation device such as asyringe. Once inflated, as with previous embodiments, the externalO-ring 12 is then grasped and gently tugged outward (proximally) to seatthe inflatable chamber 39 against the fascia. The external O-ring 12 isthen manually rolled so as to adjust to the specific distance betweenthe fascia and skin. The firmness of the external O-ring 12 acts tomaintain the position of the rolled up length, and the elastic reboundof the tubular member 31 and the tapered channel 40 provides an elasticrange to accommodate body movement when the ostomy appliance 10 is worn.Also, as with previous embodiments, the addition of an adhesive on theskin or the adhesive component where the O-ring 12 contacts may aid insecuring the ostomy appliance 10.

The ostomy appliance 10 is removed by deflating the inflatable chamber39 and pulling the ostomy appliance 10 out of the body and discarded.

In a tenth embodiment of the ostomy appliance 10, referring to FIGS. 14,15, 16, 17, 18, 19 and 20, an ostomy appliance 10 may include a seal forsealing around a stoma 41 such that the seal comprising the internalportion for sealing against the internal wall of the stoma lumenconsists of an internal inflatable chamber 39 toroidal in shape andsealed to or continuous with a tubular tapered or “trumpet-shape”central channel 40 constructed of a thin elastic material. The taperedchannel 40 may also be continuous with another external inflatablechamber 42 having thicker and/or stronger (less soft) elastic material.There are interconnecting fluid passageways 43 between the internalchamber 39 and the external chamber 42. At the entrance, exit or alongthe fluid passageways 43 there may be an orifice or other fluidrestriction, or valve to delay and/or control the initiation of thefluid transfer from the external chamber 42 to the internal chamber 39.The external chamber 42 is to be pressurized with fluid at manufactureor at some time previous to use, such that the pressure contained, whenreleased, can be utilized to transfer, via elastic action, the fluidiccomponent from the external chamber 42 through the fluid passageways 43into the internal chamber 39 so the internal chamber 39 may deploywithin the body without the need of a secondary component for inflatingthe ostomy appliance 10. The internal chamber 39 and the tapered channel40 may be constrained, e.g., folded, rolled and/or twisted, into a thin,long shape to ease insertion into the stoma 41 without the need for aninsertion tool. Gelatine or other coating 50 on the constrained membersmay facilitate insertion by maintaining the constraint until thegelatine contacts or is within the moist interior of the stoma 41. Theaddition of a cap 46 over the internal chamber 39 and constrainedmembers may also aid in maintaining the internal chamber 39 in aconstrained condition before use. Constraining the internal chamber 39may also prevent premature fluid transfer from the pressurized externalchamber 42. Attached to the external chamber 42 is an attachment covermember 44. The function of the cover member 44 is to provide a means ofeasily handling, attaching/removing and deflating the ostomy appliance10 and is constructed of a relatively rigid polymer material. On theunderside of the cover member 44 along the outer flange is a ring-shapedarea 48 that once the ostomy appliance 10 is deployed will contact thesurface around the stoma 41 on a two-piece ostomy wafer 47. Thering-shaped area 48 has alternating shallow vents 51 or spacedclearances around the perimeter to allow effluent and/or gas escape fromaround the back side of the internal seal in the event of seal failure.This ring-shaped area 48 may be coated with an adhesive between thevents 51 and/or the ostomy wafer 47 may have an adhesive for attachingthe ostomy appliance 10. Additionally, within the cover member 44 is adeflation tear-away tab 45 used to deflate the ostomy appliance 10. Thedeflation tab 45 is a break-away feature of the cover member 44 in thatthe attachment or bonding of the material of the external chamber 42 tothe attachment member 44 overlaps the perforation of the deflation tab45 such that when the deflation tab 45 is broken, the seal to theexternal chamber 42 is compromised, deflating the ostomy appliance 10.Successfully packaging the ostomy appliance 10 may be accomplished byutilizing a container pressurized with the same fluid and to the samepressure as the external chamber 42 in the non-deployed state. This mayalleviate the problem of the ostomy appliance 10 depressurizing overtime due to the permeability of the ostomy appliance 10 materials. Thepackage container may be constructed of barrier films or may be a hardpolymer or an aluminum (e.g., like a soda can) or other container thatwill hold the fluidic pressure over time until the contained ostomyappliance 10 is needed.

The tenth embodiment of the ostomy appliance 10 is removed from itscontainer, the cap 46 is removed (FIG. 15), and the ostomy appliance 10is inserted fully into the stoma 41 (FIGS. 16, 17 and 18), so as the endof the constrained portion is behind the fascia 49. The constrainingcoating 50 dissolves and the transfer of fluid from the external chamber42 to the internal chamber 39 initiates. Applying a manual downwardpressure to the cover member 44 may also initiate and/or accelerate thetransfer of fluid. The internal chamber 39 is then inflated, and theexternal chamber 42 deflated which allows the ring-shaped area 48 tocontact the surface of the ostomy wafer 47 and attach the ostomyappliance 10. Stoma effluent is then free to flow through the ostomyappliance 10 and out into a pouch without contacting other tissue.

The ostomy appliance 10 is removed by pulling the deflation tab 45 out,deflating the ostomy appliance 10, then pulling the ostomy appliance 10away from the ostomy wafer 47 and out of the body and discarded.

The eleventh embodiment of the ostomy appliance 10, referring to FIGS.21 and 22, has the same features and functionality as the tenth exceptdoes not possess an attachment cover member 44 but instead relies on theexternal inflatable chamber 42 for providing a means of easily handling,attaching/removing and deflating the ostomy appliance 10. As with thetenth embodiment there are interconnecting fluid passageways 43 betweenthe internal chamber 39 and the external chamber 42 that contains anorifice 52 or other fluid restriction, or valve to delay and/or controlthe initiation of the fluid transfer from the external chamber 42 to theinternal chamber 39. As with the tenth embodiment, the external chamber42 is to be pressurized with fluid at manufacture or at some timeprevious to use. The contained pressurized fluid, when released, maytransfer, via elastic action, the fluid from the external chamber 42through the orifice(s) 52 and fluid passageways 43 into the internalchamber 39 so the internal chamber 39 may deploy within the body withoutthe need of a separate inflation device. The internal chamber 39 and thetapered channel 40 may also be constrained and held via a coating 50, aswith the tenth embodiment, into a thin, long shape to ease insertioninto the stoma 41. A cap may be placed over the internal chamber 39 andconstrained members. Additionally, once the ostomy appliance 10 is inplace and the external chamber 42 has transferred the fluid into theinternal chamber 39 to deploy the ostomy appliance 10, the deflatedexternal chamber 42 may then be used, being now similar to the externalO-ring 12 in the ninth embodiment (FIGS. 12 and& 13), to function as anadjustment to the various fascia-skin distances via a circumferentialroll up of the tapered channel 40. Successfully packaging the ostomyappliance 10 may be accomplished similar to the tenth embodiment, byutilizing a container pressurized with the same fluid and to the samepressure as the external chamber 42 in the non-deployed state.

The ostomy appliance 10 may be fabricated in part by means of a dipmolding process. FIG. 23 demonstrates an example of a possible dip-moldmandrel tool. First the tool may be dipped in an appropriate materialcomponent up to the A-A line and allowed to cure so as to form a thin,soft, highly elastic film for the formation of the internal chamber 39and tapered channel 40. This defines the first dipping area 53.

Then the tool may be dipped in an appropriate material component up tothe B-B line and allowed to cure so as to form a thick, strong, elasticfilm for the formation of the external chamber 42. This defines thesecond dipping area 54. The second dipping area 54 may requiresubsequent dips to achieve the desired thickness. After curing of thedip-mold materials additional assembly steps will be needed to completethe ostomy appliance 10.

The eleventh embodiment of the ostomy appliance 10, very similar to thetenth, is removed from its container, the cap over the constrainedmembers is removed, and the ostomy appliance 10 is inserted fully intothe stoma 41, so as the end of the constrained portion is behind thefascia 49. The constraining coating dissolves and the transfer of fluidfrom the external chamber 42 to the internal chamber 39 initiates. Theinternal chamber 39 is then inflated, and the external chamber 42deflated which allows the deflated external chamber 42 to be used as theexternal O-ring 12 as in previous embodiments. The external chamber 42is grasped and gently tugged outward (proximally) to seat the inflatablechamber 39 against the fascia 49. The external chamber 42 is thenmanually rolled so as to adjust to the specific distance between thefascia and skin. The firmness of the deflated external chamber 42 actsto maintain the position of the rolled up length, and the elasticrebound of the tapered channel 40 provides an elastic range toaccommodate body movement when the ostomy appliance 10 is worn. Adhesiveon the surface of the ostomy wafer 47 contacting the underside of theexternal chamber 42 assists in attaching the ostomy appliance 10. Stomaeffluent is then free to flow through the ostomy appliance 10 and outinto a pouch without contacting other tissue.

The ostomy appliance 10 is removed by pulling the deflation pull-out 51,deflating the ostomy appliance 10, then pulling the ostomy appliance 10away from the ostomy wafer 47 and out of the body and discarded.

It will be appreciated that the foregoing description contains preferredforms of the invention, and that many modifications, improvements andequivalents are within the scope of the claimed invention.

1. A stoma extender comprising: a first end for insertion into a stomafor diverting stomal effluent into the stoma extender before theeffluent exits the stoma; a second end for remaining external of thestoma, for providing a discharge exit for stomal effluent; and a conduitportion coupled between the first and second ends for communicatingstomal effluent through the stoma extender, wherein the length of theconduit portion is adjustable stably, to permit adaptation of the stomaextender to an individual's stoma.
 2. The stoma extender of claim 1,wherein at least a portion of the conduit portion is configured topermit at least one selected from: at least partial rolling-up of theconduit portion along its axis to reduce the length: and/or at leastpartial unrolling of a rolled-up portion of the conduit portion alongits axis to increase the length.
 3. The stoma extender of claim 2,wherein the conduit portion is rollable from the second end to permitadaptation of the length once the first end is already inserted into astoma.
 4. The stoma extender of claim 1, wherein at least a portion ofthe conduit portion is configured to permit at least one selected from:at least partial folding-back of the conduit portion along its axis toreduce the length: and/or at least partial unfolding of a folded-backportion of the conduit portion along its axis to increase the length. 5.The stoma extender of claim 4, wherein the conduit portion is foldablefrom the second end to permit adaptation of the length once the firstend is already inserted into a stoma.
 6. The stoma extender of claim 1,wherein the first end comprises a seal for sealing against theintestinal wall.
 7. The stoma extender of claim 6, wherein the seal isselected from: an inflatable seal, and/or a seal comprising resilientfingers, and/or a seal comprising a material that expands when contactedby moisture from stomal effluent.
 8. The stoma extender of claim 1,wherein the second end comprises a member or portion that is stifferthan a portion of the conduit portion extending to the second end. 9.The stoma extender of claim 8, wherein the second end comprises a sourceof inflation fluid for the first end.
 10. The stoma extender of claim 1,wherein at least a portion of the conduit portion is elastic.
 11. Thestoma extender of claim 1, further comprising an adhesive for retainingthe second end, whereby an adjusted length of the conduit portion isstably held.
 12. A stoma extender comprising: a first end for insertioninto a stoma for diverting stomal effluent into the stoma extenderbefore the effluent exits the stoma; a second end for remaining externalof the stoma, for providing a discharge exit for stomal effluent; and aconduit portion coupled between the first and second ends forcommunicating stomal effluent through the stoma extender, wherein thefirst end comprises a seal defined by a plurality of resilient fingersextending from a support collar, and elastic webbing extending at leastbetween portions of the fingers, the fingers, support collar and webbingdefining a resiliently collapsible funnel-shape.
 13. The stoma extenderof claim 12, wherein the webbing comprises an elastic sleeve coveringthe fingers.
 14. The stoma extender of claim 12, wherein the webbing isintegrally formed with the fingers and collar.
 15. The stoma extender ofclaim 12, wherein each of the fingers comprises a tip remote from thesupport collar, the tip being curved away from an intestinal-wall-facingsurface of the finger such that, in use, the tip does not bear directlyon the intestinal wall.
 16. A stoma extender comprising: a first end forinsertion into a stoma for diverting stomal effluent into the stomaextender before the effluent exits the stoma; a second end for remainingexternal of the stoma, for providing a discharge exit for stomaleffluent; and a conduit portion extending between the first and secondends for communicating stomal effluent through the stoma extender,wherein at least the first end comprises: a tubular support member; anda first sleeve extending around at least a portion of the tubularsupport member, the first sleeve comprising material that expands inresponse to contact with moisture, whereby when the first end isinserted into a stoma in use, moisture from stomal effluent causes thefirst sleeve to expand for forming a seal between the first end and theintestinal wall.
 17. The stoma extender of claim 16, wherein the firstsleeve comprises a foam that expands when contacted by moisture.
 18. Thestoma extender of claim 16, wherein the tubular member comprises atleast one aperture for communicating moisture from inside the tubularmember to the first sleeve.
 19. The stoma extender of claim 16, furthercomprising a second sleeve extending around the first sleeve for (i)containing the first sleeve and (ii) defining a contact surface forcontacting the intestinal wall.
 20. The stoma extender of claim 16,wherein the tubular member has a bulbous or bulged shape at the firstend of the stoma extender.
 21. The stoma extender of claim 16, whereinthe tubular support member and the first sleeve extend from the firstend towards the second end.
 22. A stoma extender comprising: a first endfor insertion into a stoma for diverting stomal effluent into the stomaextender before the effluent exits the stoma; a second end for remainingexternal of the stoma, for providing a discharge exit for stomaleffluent; and a conduit portion coupled between the first and secondends for communicating stomal effluent through the stoma extender,wherein the first end and at least a portion of the conduit portion havea collapsed form prior to first use, the collapsed form being retainedby a water-soluble and/or water-dispersible glue or coating on saidcollapsed form, whereby in use, once the first end has been insertedinto a stoma, the collapsed form is released by contact with moistureform stomal effluent.
 23. The stoma extender of claim 22, wherein saidglue or coating is of gelatin.
 24. A stoma extender comprising: a firstend for insertion into a stoma for diverting stomal effluent into thestoma extender before the effluent exits the stoma; a second end forremaining external of the stoma, for providing a discharge exit forstomal effluent; a conduit portion coupled between the first and secondends for communicating stomal effluent through the stoma extender; aninflatable seal at the first end for sealing against the intestinal wallbehind a stoma; an inflation fluid reservoir for storing inflation fluidprior to delivery to the inflatable seal, the inflation fluid reservoirhaving a storage capacity sufficient to inflate the inflatable seal toan operative inflated state in use; and an inflation conduit fordelivering inflation fluid from the reservoir to the inflatable seal.25. The stoma extender of claim 24, wherein the inflation fluidreservoir comprises an elastic container for storing the inflation fluidunder pressure greater than atmospheric pressure.
 26. The stoma extenderof claim 24, wherein the inflation fluid reservoir is provided at thesecond end, or nearer the second end than the first end.
 27. The stomaextender of claim 26, wherein the inflation fluid reservoir has atoroidal shape.
 28. The stoma extender of claim 26, wherein theinflation reservoir is responsive to manual pressure applied at thesecond end, while rolling, folding, or pressing the second end towardsstoma level during fitting of the stoma extender, to urge inflationfluid out of the reservoir.
 29. The stoma extender of claim 24, furthercomprising a device for retaining the first end in a non-inflated stateuntil the first end has been received within the stoma.
 30. The stomaextender of claim 29, wherein the device comprises a water solubleand/or water-dispersible glue or coating at the first end.
 31. The stomaextender of claim 30, wherein the glue or coating comprises gelatin. 32.The stoma extender of claim 24 wherein at least the inflation fluidreservoir is initially contained within removable packaging, theremovable packaging containing a second reservoir of the inflation fluidat a pressure not substantially less than the pressure within theinflation fluid reservoir.
 33. The stoma extender of claim 32, whereinthe removable packaging is made of barrier material for blockingtranspiration of inflation fluid through the removable packaging.
 34. Astoma extender comprising: a tubular member of generally self-supportingshape, the tubular member having a first end for insertion into a stomafor diverting stomal effluent into the tubular member before theeffluent exits the stoma, and a second end for remaining external of thestoma, for providing a discharge exit for stomal effluent passingthrough the tubular member; a collar slidable along at least a portionof the tubular member from the second end; and a selective engagementdevice for providing selective engagement between the collar and thetubular member, the selective engagement device being at least oneselected from: (a) a directionally selective engagement device thatpermits sliding movement of the collar on the tubular member in adirection away from the second end, and which produces engagementbetween the collar and the tubular portion to resist movement of thecollar in an opposite direction towards the second end, and/or (b) amanually selective engagement device responsive to manual operationbetween an engaged condition for retaining the collar at a position onthe tubular member, and a non-engaged condition that permits slidingmovement of the collar on the tubular member.
 35. The stoma extender ofclaim 34, wherein the directionally selective engagement devicecomprises a plurality of fingers configured for permitting slidingmovement in one direction, and for resisting sliding movement in saidopposite direction.